Healthcare Provider Details

I. General information

NPI: 1184616401
Provider Name (Legal Business Name): ROBERT E ARNSDORF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 COUNTRY CLUB RD
EUGENE OR
97401-2477
US

IV. Provider business mailing address

242 COUNTRY CLUB RD
EUGENE OR
97401-2477
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-4242
  • Fax: 541-343-5078
Mailing address:
  • Phone: 541-683-4242
  • Fax: 541-343-5078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD00036488
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number162055
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier151320
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
Identifier8922561
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerCRIME VICTIMS
# 3
Identifier8230864
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 4
Identifier0308675
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerWASHINGTON L&I

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: